86.Although the Cabinet Office provides support to departments to prepare for biological risks and identify the necessary capabilities (see Chapter 3), the day-to-day responsibility for biological security sits across several Government departments and agencies, as well as with the devolved administrations and planners at the regional and local level (see Chapter 4). Most relevant to our inquiry, the Department of Health and Social Care (DHSC) prepares for disease outbreaks amongst the public, aiming to “understand the public health threats we face, prevent these where possible, rapidly detect any that occur, and respond effectively to disease outbreaks”. Additionally, other Government departments and agencies—such as the Home Office, the Department for Environment, Food & Rural Affairs and the Foreign, Commonwealth and Development Office—act to prepare for biological risks that affect their areas of responsibility.
87.There can be good reasons for such a split. Having a lead Government department for a particular area can increase accountability to Parliament and the public, as well as encourage the department to take its emergency planning duties seriously.
88.The 2018 Biological Security Strategy did not aim to duplicate the existing work of departments and other organisations, but rather to “ensure that a cross-Government approach to biological security is maintained”. To coordinate that work, the Strategy foresaw a new governance board to oversee cross-departmental commitments. It stated that the board would be composed of representatives from the following departments:
89.The Government told us that there is a two-tier governance structure for implementing the Strategy: a senior Governance board and a Working Group. It said that these enable relevant departments, agencies and devolved administrations to work together. The governance board had met twice since the publication of the Strategy, and the working group “much more frequently” (approximately 12 times).
90.The National Security Council (NSC) is intended to act as the “main forum for collective discussion of the Government’s objectives for national security”. The Biological Security Strategy envisaged that its governance board would report to the Threats, Hazards, Resilience & Contingencies subcommittee of the NSC. The Government Chief Scientific Adviser, Sir Patrick Vallance, had ‘direct oversight of the Strategy’s outcomes’, although Sir Patrick himself suggested to us that this was not a highly active role. That NSC sub-committee has not been re-established in this Parliament. Although the NSC’s new covid-19 sub-committees (‘covid-19 strategy’ and ‘covid-19 operations’) may have absorbed some of this remit, it is not clear where final accountability now lies for activities to tackle other pressing biological risks, not least pandemic flu, other emerging infectious diseases, antimicrobial resistance and the release of biological agents. We note that the Government’s written submission to our current inquiry has significantly less detail on governmental activity on biological risks beyond pandemics than its submission to our predecessor Committee’s earlier inquiry.
91.Some contributors to our current inquiry were concerned about what they saw as insufficient leadership of the UK’s overall biological security work, and ineffective cross-departmental working. Major General Jonathan Shaw—with previous experiences of the Cabinet Office Briefing Room (COBR) system—warned of an absence of direction from the centre of Government in response to cross-departmental crises. Instead of direction, he identified an “accumulation of departments”, each with its own agenda and ambitions as they competed for resources. He compared Whitehall to a “polo mint”, with a hole at the centre. Similarly, the School of International Futures argued that, while there is good quality “expert advice and threat assessment” in the UK, preparedness “falls down in the cross-departmental responses and coordinating interventions across the local, national and international levels”. They warned that, despite a 2013 review which enhanced cross-government horizon scanning, there was “little evidence” that this form of monitoring was “taken sufficiently seriously at a senior level to be systematically converted into policy and resourced in contingency planning other than by the Civil Contingency Secretariat.”
92.The LSE IDEAS Centre argued that current strategies—such as the 2015 Strategic Defence and Security Review, the 2018 National Security Capability Review and the Biological Security Strategy—had over-focused on abstract high-level coordination between departments, but not enough on the operational response. It proposed that future resilience exercises should pay greater attention to “developing, refining and normalising the working practices” for security and resilience, warning that “these links can atrophy or become ineffective rapidly if not regularly exercised and refreshed”.
93.Some witnesses warned that preparations for future crises may fall off departmental agendas, especially at times of financial pressure or when these is limited external auditing or scrutiny. Individual departments are responsible for deciding how much resource to dedicate to preparations for biological (and other security) risks. As Lord Sedwill explained, individual Secretaries of State must “balance off their pure departmental responsibilities and the national risks for which they are responsible”.
94.Roger Hargreaves rejected the idea that departments’ biological security work does not undergo scrutiny. He told us that:
We [the Civil Contingencies Secretariat] push and prod departments all the time on their full range of risks to ensure that they have active plans in place. Ultimately, the responsibility sits with them, but we can offer quite a lot of support as well as push pretty hard. There are plenty of examples at any given time of where we are pushing departments to make sure that they have things in good shape for emerging risks.
Penny Mordaunt, however, told us that the Cabinet Office could have a “more robust role in ensuring that the right things are being done”. For her, one of the lessons of covid-19 was “not to allow departments to mark their own homework” but rather for the Cabinet Office to act as a “critical friend” to “ensure the robustness of plans and exercises”. She also supported greater capacity-building amongst ministers and a more “methodical approach” to supporting them to respond to crises.
95.Reflecting on possible problems with investment in biological security preparations, Helen Ramscar judged that:
The UK talked a good talk about pandemic preparedness but this does not appear to have translated into deep dives across departments to anticipate far-reaching ramifications and invest. There were warnings of the sheer scale. One assessment of the impact and cost of the 2003 SARS outbreak [ … ] put the cost to China alone at US$6.1 billion.
To avoid a tendency for preparations to “fall prey to financial cuts”, Dr Patricia Lewis from Chatham House recommended a requirement on Government to report annually to Parliament on the state of national preparedness, including exact levels of stocks of essential materials and the number of drills, exercises and simulations organised. This was endorsed by Dr Filippa Lentzos and Professor Michael Goodman of King’s College London. The Government Chief Scientific Adviser and the Medical Director for Preparedness at PHE saw a need for greater spare capacity and contingent capabilities.
96.The National Audit Office concluded in September 2020 that the civil service can improve how it undertakes contingency planning, for example having robust contingency plans for high-impact scenarios that could reasonably occur, even if some “may not be the desired outcome” (referring in this case to EU Exit preparations).
97.The absence of the NSC sub-committee on Threats, Hazards, Resilience and Contingencies raises questions for the UK’s wider Resilience Capabilities Programme, given that this sub-committee bears ultimate responsibility for the programme. This sub-committee was intended to bring “greater senior oversight of the UK’s security and resilience”. Ensuring robust oversight of contingency planning across the civil service is consistent with the ‘Fusion Doctrine’, which aims to improve the UK’s “collective approach to national security”. Establishing clear lines of leadership may also help to overcome some contributors’ suggestions that the Government has at times ‘hid behind’ or been a passive recipient of the work of others—such as the technical experts within the Scientific Advisory Group for Emergencies.
98.There is a striking absence of strategic leadership of the UK’s biological security work as a whole. Several Government departments have an important role in preparing for biological risks to the UK’s security, but the NSC sub-committee (‘Threats, Hazards, Resilience and Contingencies’) to which departments are supposed to report no longer exists. Neither the National Security Council nor the Cabinet Office provides sufficient collective strategic leadership of departments’ work to address biological risks. This governance gap, it seems to us, may also affect other cross-departmental security challenges, beyond the biological sphere. Without stronger direction from the centre of Government, we are concerned that long-term planning activities integral to the UK’s biological security and other cross-departmental challenges may drop off departmental agendas (particularly at times of financial pressure), or remain in departmental silos despite the objectives of the Fusion Doctrine. The failure to re-appoint the relevant NSC sub-committee may also undermine the Resilience Capabilities Programme, for which this sub-committee was previously responsible.
99.The Government should designate a task force within the Cabinet Office with explicit responsibility for assessing departmental capabilities and resilience, as well as providing strategic collective leadership of the UK’s biological security efforts. Such a task force should:
a)monitor operational progress on the commitments in the Biological Security Strategy, and act as a ‘critical friend’ to departments. Assessing the information reported annually by the Strategy’s governance board would be the starting point for its work;
c)have an explicit audit role to check that all relevant departments and agencies actually implement planned emergency response capabilities (or ensure that the National Security Council fulfils that role).
100.The Government should ring-fence funding for Government departments to undertake horizon-scanning and preparedness activities to strengthen their resilience to a range of major disruptive events (including biological emergencies). Such funding should cover a multi-year period to avoid artificial incentives to undertake only smaller (annual) exercises, rather than larger/non-annual exercises. The Civil Contingencies Secretariat and Government Office for Science should continue their advisory role, working proactively with the NSC in monitoring risks. They should also review how their risk horizon-scanning work can best support the creation of SAGEs as particular emergencies materialise.
101.Many contributors to our inquiry were concerned by the ways biological risks to human health are treated within wider security planning processes, relative to other areas of national security. Hamish de Bretton-Gordon, an expert on chemical and biological weapons, described biological security as the “poor relation” of other security domains, such as cyber-security. The LSE IDEAS Centre argued that tier-1 health risks had been under-examined in past national security reviews. Only two out of 89 commitments in the 2015 Strategic Defence & Security Review explicitly related to public health risks. By way of comparison, actions to address cyber threats, another tier-1 risk, involved 12 commitments. Similarly, Ed Arnold of The D Group pointing out that the Biological Security Strategy was “delivered two years behind schedule”. He stated that available evidence suggests “other risks and threats were prioritised” over public health risks. He speculated that the UK’s “recent and direct” experience of the other five tier-1 threats in the National Security Risk Assessment might have led to a “failure of imagination” when planning for a pandemic’s impacts. Professor Sophie Harman highlighted how health security is separated out from wider security objectives:
A distinct Biological Security Strategy is welcome, but exacerbates the separation between health security and wider UK security priorities. Lack of integration between ‘traditional’ threats—intelligence, conflict, peace—and ‘new’ security threats such as pandemics, runs the risk of health emergencies falling between the cracks of two governance systems or a privileging of specific threats, issues, and actors over others.
102.Security risks encompass a mixture of accidental and natural events (hazards), and malicious attacks (threats). In July, the then National Security Adviser, Lord Sedwill, told us that threats may have been prioritised at the expense of hazards in security planning. He explained that government typically organises itself around threats such as state-based threats or terrorist threats, even though natural hazards can have “more severe consequences than any of the classic national security threats”. Dr Jennifer Cole told the Defence Committee that there had been a general under-resourcing of preparedness activities for ‘non-man-made threats’, ever since threats and hazards began to be separated in the National Risk Register.
103.We asked the House of Commons Scrutiny Unit to compare spending on the six ‘tier-1’ security risks identified in 2015. However, it was not possible to draw definitive conclusions about the relative spend on hazards and threats. Analysing spending on these priorities is complicated, and most risk areas are open to interpretation of where the spending boundary lies.
104.An important way of judging whether preparedness decisions are well-founded is through testing exercises and drills. The Government calls exercises at the national and local level an “essential element of the Government’s resilience and preparedness programme”. It described these as a way of ensuring plans are “fit for purpose” and exercises can identify potential gaps or issues in a planned response. They also fulfil a training and quality assurance function.
105.The Government also has statutory responsibilities in relation to assuring ‘readiness’ for health emergencies, telling us that:
The NHS England Emergency Preparedness, Resilience and Response (EPRR) Framework, sets out that providers and commissioners of NHS funded services must show they can effectively respond to major, critical and business continuity incidents whilst maintaining services to patients. NHS England has an annual statutory requirement to formally assure its own and the NHS in England’s readiness to respond to emergencies. The Civil Contingencies Act 2004 and the NHS Act 2006, as amended by the Health and Social Care Act 2012, underpin EPRR within health. Both Acts place EPRR duties on NHS England and the NHS in England [but not on the devolved administrations].
106.Large-scale cross-government pandemic preparedness exercises (see below) occur “at regular intervals”. At the local level, it said that resilience arrangements are “routinely and regularly exercised”. By far the largest cross-departmental biosecurity exercise in the last decade was ‘Exercise Cygnus’: a three-day ‘command post’ exercise led by Public Health England in October 2016, which tested England’s ability to work at the peak of a pandemic influenza outbreak involving over 950 people. The Government gave us details of other exercises on biological security, as well as non-biological emergencies. Although the Government has also committed to local-level and sector-specific exercises, we do not have data on the number of such exercises that have occurred.
107.A report of the results of Exercise Cygnus has been made public (after a 4-year delay and following its leaked publication in the media earlier this year), but limited information is available on the results of the other biological security exercises shared by the Government, meaning it is not possible to assess their scope, participation levels, or results.
108.Exercise Cygnus exposed important gaps in the UK’s capabilities for responding to a serious disease outbreak—a scenario in which a pandemic influenza outbreak affected 50% of the population and could cause 200,000–400,000 excess deaths. The exercise report judged that:
The UK’s preparedness and response, in terms of its plans, policies and capability, is currently not sufficient to cope with the extreme demands of a severe pandemic that will have a nation-wide impact across all sectors.
It highlighted a need for a central repository of information to cover the preparedness and response of the multiple sectors involved, highlighting that “individual organisations’ responses rely on a corporate memory of the 2009 H1N1 influenza response” which was being lost. It recommended legislative adjustments to assist with the response to any ‘worst case scenario pandemic’ and an improvement to the understanding of likely public reactions. It also warned that the capability and capacity to surge resources into key areas was sometimes lacking and recommended further support to build up the local response in the areas of excess death planning, social care and health.
109.Exercise Cygnus was a large-scale and complex cross-sector exercise, involving national and local activity, of a kind that “usually take[s] at least a year to plan”. Penny Mordaunt explained to us that such large exercises are infrequent due to the “enormous efforts” needed to run them. Beyond tier-1 exercises, “officials regularly undertake exercises for a range of threats and hazards”. The Minister explained that devolved administrations run their own exercises in areas of devolved competence, and take part in tier 1 exercises, where relevant. Professor Simpson from Public Health England told us that exercises are “based on the national risk assessments and what NHS England, the DHSC and we [PHE] regard as the highest and most pertinent threats at the time”. Penny Mordaunt said that in recent years there have been fewer large exercises and “less opportunity for Ministers to rehearse what they might be required to be involved in”.
110.Cygnus was designed to cover certain stages of a pandemic response (Treatment, Escalation) and did not include others (Detection, Assessment, Recovery). In other words, Cygnus did not test the rollout of personal protective equipment or ventilators, nor did it appear to exercise testing capacity or any test-and-trace detection system. Professor Simpson from Public Health England had been directly involved in Exercise Cygnus, and underlined for us the challenge of undertaking “long-term stress testing”, because it was not possible to take people out of their jobs for a month to participate. Clara Swinson from the Department of Health and Social Care believed that the UK is “undoubtedly in a better position” as a result of Exercise Cygnus, but added that “people have reasonable questions about [ … ] whether [some] things should have been tested, including at a local level”.
111.Aspects not covered in Exercise Cygnus mean that the Detection, Assessment and Recovery stages of a pandemic response have not been tested in any large-scale exercise since at least 2010 (if ever). Accordingly, as the Minister told us, at the start of the covid-19 pandemic, the Government had not tested for “extreme pressures on global supply chains and PPE”, nor had it considered how public sector systems might integrate with those of private sector providers. She added that unique aspects of coronavirus were “not well planned for”, for example the highly infectious nature of the disease and the broad demand on PPE across virtually all sectors. The stockpiling of clinical countermeasures and the development of surveillance and testing capabilities (discussed in Chapter 3) were “not central to the exercises that had been done”.
112.The process for implementing and sharing the results of exercises is not clear. The report of Exercise Cygnus was not published until 2020 (four years after the exercise), and although it was circulated to the participating departments and LRFs “quite soon” after being produced, the individual Ministers who participated “may not have been sighted on the report at the time” (due to individuals moving on from their posts). Ed Arnold from The D Group questioned why Exercise Cygnus received no mention in the 2018 Biological Security Strategy, despite its significance. Similarly, we note that a relevant exercise held in Scotland in 2018—which focused on Middle East Respiratory Syndrome (MERS-CoV) and identified potential problems with PPE availability and community testing—may not have been fully taken on board by the UK Government.
113.Roger Hargreaves told us that there is debate over how open the results of exercises should be. In the case of Cygnus, the Secretariat sought a balance between actively sharing results with participants and interested organisations, while keeping them closed enough to protect the “safety and the honesty that you get [from participants] in exercises” and to safeguard sensitive security information. The Government told us that it did learn the lessons of Exercise Cygnus and that lessons had informed the preparation of draft legislation for future influenza pandemics (across Government and with devolved administrations); helped departments to strengthen resilience in their sectors; led to the establishment of an expert advisory group on the “moral, ethical and faith considerations” before and during a pandemic; established better health and care plans to “flex systems and resources”; and generated best practice through a new Resilience Standard for Local Resilience Forums. Cygnus prompted work to develop pandemic response capabilities in acute care, community care and adult social care.
114.Many contributors were supportive of the role exercises play in testing capabilities and preparing the country for biological (and other) emergencies, but also suggested that such exercises required greater priority. Ed Arnold of The D Group criticised the six-year gap between the identification of the public health security risk in 2010 and the first large-scale exercise. The LSE IDEAS Centre pointed out that the WHO recommends annual exercises to test biosecurity plans. They advocated regional and local resilience exercises to model the impacts of diseases and other biosecurity risks across the country, led by local authorities.
115.The Government’s programme of biosecurity exercises is inadequate. There has only been one ‘tier 1’ national biosecurity exercise in the last decade (Exercise Cygnus), and because of its size it was decided not to test several important capabilities critical for a pandemic response. Holding more exercises would, between them, allow all capabilities to be covered. We are concerned that the results and lessons of exercises are not fully shared; Exercise Cygnus was not even mentioned in a Biological Security Strategy published only two years later.
116.The Government should plan and undertake a regular programme of exercises to test the UK capabilities for responding to all tier-1 security risks (natural hazards as well as malicious threats), as well as exercises to test simultaneous multi-risk scenarios (paragraphs 102, 126). Within central government, table-top exercises should occur at least once a year and large-scale ‘tier 1’ cross-departmental exercises at least once every three years, involving enough departments to allow for an appropriately wide ‘Fusion Doctrine’ response to be tested. These exercises should aim (a) to strengthen emergency response capabilities applicable to a range of scenarios, without being too closely tailored to the characteristics of highly specific risks, and (b) include local-level exercises in combination with central agencies and departments in order to test local/central interfaces and data-sharing.
118.The challenges the UK has faced in the covid-19 pandemic reflect longer-term gaps in the systems for planning and preparing for biological risks. While the Government has identified top-tier biological risks to the UK’s national security, that assessment does not appear to have had the required practical effects in terms of exercising and mitigation. This raises questions over the impact of the risk identification and ‘tiers’ system of the National Security Risk Assessment in practice.
119.The Government should re-assess how well the risk identification and ‘tiers’ system of the National Security Risk Assessment process are informing the level of preparation, resource allocation and mitigating activities dedicated to individual security risks.
120.To strengthen the implementation of actions to mitigate high-priority biological risks, the Government should also publish an operational action plan for the principal commitments of the Biological Security Strategy which outlines—for each commitment—the timescale, responsible team and department, resource allocation and means for measuring its progress and impact.
192 Her Majesty’s Government, (July 2018), p 39
193 Her Majesty’s Government, (July 2018), pp 39–40
194 Roger Hargreaves,
195 Her Majesty’s Government, (July 2018), p 37
196 Her Majesty’s Government, (July 2018), p 7
197 Her Majesty’s Government (). This evidence also refers to a Pandemic influenza Readiness Board, which aims to improve cross-Government work on preparedness for a future (flu) pandemic. This Board is chaired by the Cabinet Office and the Department of Health and Social Care, and includes representatives of the Devolved Administrations.
198 Clara Swinson,
199 Her Majesty’s Government, ‘’, accessed 14 December 2020
200 Her Majesty’s Government, (July 2018), p 7
201 Sir Patrick told us that this role specifically involves reviewing and commenting upon an annual progress report. Sir Patrick Vallance,
202 Her Majesty’s Government, ‘’ (19 November 2020)
203 Compare Her Majesty’s Government () and written evidence received by Joint Committee for Biosecurity and human health inquiry, Session 2017–19, Her Majesty’s Government ()
204 Major General Jonathan Shaw () para 10
205 School of International Futures ()
206 Cabinet Office, (21 January 2013)
207 School of International Futures ()
208 LSE IDEAS () paras B1, D17
209 LSE IDEAS () paras A4, C1
210 Dr Patricia Lewis (); Dr Jennifer Cole,
211 Lord Sedwill,
212 Roger Hargreaves,
213 Penny Mordaunt, ,
214 Helen Ramscar () para 2.12
215 Dr Patricia Lewis ()
216 Dr Filippa Lentzos and Professor Michael S. Goodman ()
217 Sir Patrick Vallance, ; Professor John Simpson,
218 National Audit Office, (4 September 2020)
219 Cabinet Office, (30 May 2018)
220 Her Majesty’s Government, (November 2015), para 4.129
221 Her Majesty’s Government, (March 2018), p 3
222 For example, Sir Lawrence Freedman () para 4; Professor Bouder,
223 Hamish de Bretton-Gordon (); see also Professor Sophie Harman () para 5
224 LSE IDEAS () para D13; Dr Jennifer Cole,
225 This point is made by LSE IDEAS () para D13. However, this contributor counts only one commitment directly related to health, whereas our Committee count two commitments. Those commitments related to providing response assistance abroad and producing a Biological Security Strategy. See commitments 43 and 70 in Her Majesty’s Government, (March 2018), pp 46–49
226 Commitments 1, 29–37, 75, 83.
227 Ed Arnold () para 2. The Strategic Defence and Security Review 2015 committed to the publication of a biological security strategy in 2016.
228 Ed Arnold () paras 1, 8
229 Professor Sophie Harman () para 5.3
230 Lord Sedwill,
231 Oral evidence taken before the Defence Committee on 14 July 2020, HC (2019–21) 357, [Dr Jennifer Cole]
232 In the 2015 Strategic Defence and Security Review, these six risks were: Terrorism, International military conflict, Cyber, Public Health, Major natural hazards and Instability overseas. See Her Majesty’s Government, (November 2015), pp 85–86
233 For example, spending on terrorism could be considered solely through the budget of/spending by the Office for Security and Counter-Terrorism (OSCT). However, spending on the wider police is also likely to have an impact on the terrorism risk; and it may be considered that not all OSCT spending is specifically on the terrorism threat.
234 Cabinet Office ()
235 Department of Health and Social Care, ‘’ (5 November 2020)
236 Roger Hargreaves,
237 Cabinet Office ()
238 Her Majesty’s Government ()
239 Smaller biological security exercises relevant to human diseases were: a ministerial exercise in February 2020, directed by the CCS with PHE’s support; an exercise in 2019 within the Scientific Advisory Group for Emergencies (SAGE) to test the process and advice for responding to a zoonotic animal disease outbreak (2019); and an exercise on Ebola Medevac arrangements. There was also an animal health exercise in 2018 to test an outbreak of Foot and Mouth disease. In addition, the Government also told us of two exercises prior to 2010 to test the UK’s resilience to an influenza pandemic. Cabinet Office (); Her Majesty’s Government ()
240 These included exercises to prepare for the UK’s withdrawal from the European Union (2019), a national electricity supply failure (2018 and 2020), flooding, and a severe weather event (2017). SAGE has also run exercises linked to a civil nuclear accidents (2018) and malicious radiological release (2018). The Government said that this list is indicative, not comprehensive. Cabinet Office ()
241 PHE, (2017), p 6
242 H1N1 influenza was popularly called swine flu. See NHS, ‘’, accessed 14 December 2020.
243 PHE, (2017), p 7
244 PHE, (2017), pp 6–9
245 Cabinet Office ()
246 Penny Mordaunt,
247 Cabinet Office ()
248 Professor Simpson,
249 Penny Mordaunt,
250 Five phases of pandemic response are identified in the UK Strategy for responding to an influenza pandemic. These are summarised in Department of Health and Social Care, ‘’ (5 November 2020). These stages are detection (beginning from when the WHO declares a pandemic, or sooner based on “reliable evidence”); assessment (beginning which the first patient in the UK with the pandemic strain of influenza is identified); treatment (when the disease spread has not been contained and there is a focus is on treating cases and responding to more patients); escalation (when service delivery arrangements are adjusted to meet pressures on services and wider society); recovery (when, following the peak of the pandemic, there is emphasis on returning services to normal, restoring business, and planning for, preventing and responding to a possible second ‘wave”).
251 Professor John Simpson,
252 Clara Swinson,
253 Penny Mordaunt,
254 Penny Mordaunt,
255 Penny Mordaunt, ; see also Roger Hargreaves,
256 Ed Arnold () para 6
257 ‘Exercise Iris’ was run by the Scottish Government Health Protection Division in 2018 to test the readiness of NHS Boards in Scotland to respond to an outbreak of Middle East Respiratory Syndrome (MERS-CoV). This involved a table-top exercise over a single day between emergency responders. Scottish Government, (12 March 2018).
258 For instance, see , BBC News, 5 June 2020.
259 Roger Hargreaves,
260 Her Majesty’s Government ()
261 Department of Health and Social Care, ‘’ (5 November 2020)
262 Dr Patricia Lewis (); School of International Futures (); Ed Arnold () paras 5, 7; Dr Filippa Lentzos and Professor Michael S. Goodman (); LSE IDEAS () paras A1–A6
263 Ed Arnold () para 5
264 LSE IDEAS () para A1
265 LSE IDEAS () para A3.